Dr. Harley has received consulting fees (more than $10,000) from ImmunoVision, holds patents related to autoantibodies and antigens, and serves on the Board of Directors of Ivax Diagnostics, Inc.
Clinical criteria for systemic lupus erythematosus precede diagnosis, and associated autoantibodies are present before clinical symptoms†
Article first published online: 28 JUN 2007
Copyright © 2007 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 56, Issue 7, pages 2344–2351, July 2007
How to Cite
Heinlen, L. D., McClain, M. T., Merrill, J., Akbarali, Y. W., Edgerton, C. C., Harley, J. B. and James, J. A. (2007), Clinical criteria for systemic lupus erythematosus precede diagnosis, and associated autoantibodies are present before clinical symptoms. Arthritis & Rheumatism, 56: 2344–2351. doi: 10.1002/art.22665
The opinions and assertions contained herein are private views of the authors and are not to be construed as official or as reflecting the views of the US Department of the Army, Navy, or the Department of Defense.
- Issue published online: 28 JUN 2007
- Article first published online: 28 JUN 2007
- Manuscript Accepted: 22 MAR 2007
- Manuscript Received: 1 NOV 2006
- NIH. Grant Numbers: AI-31584, AR-48045, AR-49084, AR-45084, AR-45451, RR-15577, AR-48940, RR-20143, AI-62629, AI-50350
- US Department of Veterans Affairs
- Oklahoma Medical Research Foundation
Specific events that occur during the development of systemic lupus erythematosus (SLE) can be quite variable among individual patients. The aim of this study was to identify patterns that distinguish early clinical events in SLE and to assess whether the presence of associated autoantibodies precedes the fulfillment of clinical criteria.
Through a retrospective chart review of military medical records, 130 patients who met the American College of Rheumatology (ACR) criteria for the classification of SLE were identified. The initial time at which each criterion was fulfilled was recorded. Autoantibody analysis was performed on serum samples, using enzyme-linked immunosorbent assays or immunofluorescence.
The clinical features that were observed earliest were discoid rash and seizures, which developed a mean 1.74 and 1.70 years, respectively, before the diagnosis of SLE; however, arthritis was the criterion that was most commonly observed before diagnosis. The presence of IgG rheumatoid factor (IgG-RF) preceded the development of arthritis in 15 (94%) of the 16 patients who were positive for IgG-RF and in whom arthritis developed (Z = 10.2, P < 0.0001). Analogously, IgM-RF appeared before the development of arthritis in 13 (76%) of 17 patients. Anti–double-stranded DNA antibodies were associated with renal disease and appeared before evidence of nephritis in most patients (92%) (Z = 13.3, P < 0.0001). An analysis of the appearance of autoantibodies compared with the appearance of clinical criteria not associated with them revealed no significant temporal relationship.
Symptoms associated with the ACR criteria for classification of SLE are commonly present before the diagnosis of SLE, and development of organ-associated autoantibodies generally precedes the appearance of their associated clinical features.